Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT Permit #: ELR2011 -00056
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/09/2011
Parcel: 2S101 DB00100
Jurisdiction: Tigard
Site address: 7340 SW HUNZIKER RD 210
Project: Cornerstone Subdivision: Lot: 0
Project Description: Low voltage for voice and data.
Contractor: AF TECHNOLOGIES Owner: HILLTOP BUSINESS CENTER LLC &
PO BOX 6551 HUNZIKER LLC
BEAVERTON, OR 97005 9430 NW KAISER RD
PORTLAND, OR 97231
PHONE: 503 -466 -2900 PHONE:
FAX: 503 - 466 -2922
FEES
Description Date Amount
Specifics: Restricted Energy Permit 03/09/2011 $75.00
12% State Surcharge - Electrical 03/09/2011 $9.00
Type of Use: COM
Class of Work: ALT
Total Number of Systems: 1
Audio & Stereo: N Boiler Controls: N
CCTV: N Clock Systems: N
Data & Telecommunications: Y Fire Alarm: N
HVAC: N Instrumentation: N
Intercom /Paging: N Landscape /Irrigation: N
Landscape Lighting: N Medical: N
Nurse Calls: N Protective Signal: N
Security Alarm: N Other: N Total $84.00
Other Desc: Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done i - ccordance approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. A' ENTION: Oregon - uires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 -001 $010 through OAR 952 ' 1 -009 ou may obtain a copy of the rules or direct questions to OUNC by callin�.6O7.232.1987 or 1.800.332. 44.
Issued 11111 / �t. i/L �� Permittee Signature. _ �`T
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease or rent.
OWNER'S SIGNATURE: Date:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC' Date:
LICENSE NO.
Call 503.639.4175 by 7:00 a.m. for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Mar, 9. 2011 12:22PM Trilogy Custom Homes No.1334 P. 2
Electrical Permit Application FoR of 11(1 1- sF (.. 1.1
City of Ti ` A � � , Reee;vea Tigard C k.,, lir ; ? R C1�1' % � Permit N° : e oa -DOD 5
13125 SW Hall Blvd., Tigard, OR 9 plan Rnview
T' I . Phone: 503.718 -2439 Fax: 503.598. C ' D atrJB ; Otber Permit: ‘si
- I U - ,ti R 1> Inspection Line: 503.639.4175 9 'L ' Date Ready/sy: lurk: g sec Page 2 for
Internet: www.tigard- ar.gov \ A� Notied/Mcthmh Supplemental Information
M
ti
® New construction ❑ Addition/alteration/replacement Please check all apply (submit i seta of plans w/iteum checked below):
DJ El Service or feeder 000 amps or more ❑ Building over three stories.
Demolition ❑ Oth er where the available fault current ❑ Marinas and boatyards.
{ , . ' exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
❑ 1 - and 2- family dwelling leas to ball enCCeda ❑ Commercis[ -use agricultural
� I Commercial/industrial ❑Ac cess ory building amps ft,r all other installations, buildings,
❑ Multi family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of KVA or
r , , r . f r x s ❑Emergency system. larger separately derived system.
b_.1__..,._ - . ...t r..: r, .. - ..� z^s-�.., . .. - -4. , `, x, n ry - i ,';,''.......4.-. , .�_I:1 , . .V ,r,, ❑ Addition of new motor load of ❑ .. " 1 .2.... 1 3 „
Job no.: f 0 Job site address. `FD s t ' 1 IO011P or more occupaacy.
^r 1 1 ^ • ❑Six ar mare ra eidcn tud units, ❑ Recreational vehicle parks,
City /State/ZIP: ' arc az q72 2 ❑ Health -care facilities, ❑Supply voltage for more than
Si . - ous locations 600 volts nominal,
Suite/bldg. /apt. no.: Project name:
Hazard
G� ❑ Service or feeder 600 p
Jam i , am eormarc ..!- ' F . i
Cross street/directions to job site: Coy' er - f , lon ' . T._? . y..lr� .
. .u ..''
Total
New residential single- or multi - family dwelling unit.
Inclu attached garage
Subdivision: I.ot no.: 1,000 sq. ft. or less _ 168.54 4
Tax map/parcel no,: Ea, add'l 500 sq. ft. or portion 33.92 1
+ „ . r2 i`5v { n Li mited energy, residential
.u.. � ` .. , c r. .., . ) d �,, .7 � With above " • . ft. 75.00 2
s . w �� ii M i .....,. . .., f aove
Amlted energy, m 1
multi-family
�!�r _ • ,y
residentialLvith above sq. ft. 75.00 2
Services or feeders installation, alteration and/or relocation
20 amps to leas 133. 2
'tr l :. 4 sb1 .; �'4 t1SC a IX d , 4 4 d 11,4 201 Sill to 400 amps 133.Sb 2
r .1 � t> i avr r `� s 2 , � Y �i � a t �� �`,^ " r � - , +, t
u.. r ..., �. :.", r., .,'f „ 3N"� � ,...." "h.,.v, ;, . x.. ._ •
-.. � {" r �' i -?':'-.:"..%`,11':.-2...:,,,,','. ps
Name: 401 amps to 600 amps 1.1 200 2
601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 552.26 2
City/State/ZIP: Temporary services or feeders installation, alteration, and/or
relocation _
Phone: ( ) Fax: ( ) 200 amps or less 59.36 1
III
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 125.08 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168,54 2
Branch circuits - new, alteration, or extension, r er • ncl
Owner signature: Date: for branch circuits with
1 ' , r µ , above service or feeder fCC,
7 - 42 2
Business name: 4 F ? � �
H. Fee for branch circuits without
service or feeder fee, first
Contact name: 0 #il. - (4 . A__ C. 1 branch circuit 56 -1 A 2
Each add't branch circuit I 7.42 2
Address: Miscellaneous service or feeder not included
City /State/ZIP:
Each manufactured or modular ii
dwelling, service and/or feeder 67.84 2
Phone: ( ) Fax:: ( ) Reconnect only 67.84 2
E -mail:
Pump or irrigation circle 67.84 2
1:1.,..:;,: y ., r t , ? r n. tt 3 r , t t , H. r^
Sign or outline lighting 67.84 2
`
w ..n; „_� o- . a e St 4 :K r ..- i S,Wlal circuits) or limited .energy
i `.« - panel, alteration, or extension, Pa$e 2 2
• Each additional inspection over allowable in any oldie above
Address: T ter. .. 1 Additional inspection (1 hr min) 6625/ hr
City /Sidle /ZIP: - 0 ��']Dt1a•7 Investigation (1 hr min) 6625/hr
44! . a r, 0 1 V Industrial plant (I hr min) 78.18/ hr
Phone: 503 '4 , 2gOp Fax: 605. - 9 Inspectically
ons for w sted %x hich hr mm no fee is • 90.00/ lu
s, rfi
CCB Lie r Electrical Lie.: j
t
R •r M. ..
Suprv. Electrician signature, required: F' ' F Subtotal: . -.
f Plan review (25% of permit The):
Print name: M [ 4 f 4' So Q ;, • . i r ate: a i1� State surcha (12% of permit fee): _ / --
Authorized signature:
iiaf• �ia TOTAL PERMIT FEE: P
This permit application expires ifs permit is not obtained within 180
Print name:` �+ k ' `. ¢ { ■ days after It has been accepted as complete.
Date: I ' Number of inspections allowed
mapecri per Pe rmit.
1: muildiaeperntitooELC- ramivlpp.doc 07/01110 410.4615T(I1/ol /COM/w®
Mar. 9. 2011 12:22PM Trilogy Custom Homes No,1334 P. 3
Electrical Permit Application -r City of Tigard
Page 2 - Supplemental Information.
LIMITED ENERGY PERMIT FEES:
y �.'T r" �r r , tL "R +y �/C sl t♦+� r r
Fee for 11j residential systems combined $75.00
Check Type of Work Involved;
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ Other:
Fee for each commercial $75.00
system
(SEE OAR 918 -309 -0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
2r Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial. systems: _
*No licenses are required. Licenses are required
for all other installations
i; \Euildjoe9c mcom_C- pumitApo doc o7/01 /l0